Provider Demographics
NPI:1851400840
Name:DENTAL ARTS OF SANTA FE, PC
Entity Type:Organization
Organization Name:DENTAL ARTS OF SANTA FE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-986-0606
Mailing Address - Street 1:312 CATRON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1806
Mailing Address - Country:US
Mailing Address - Phone:505-986-0606
Mailing Address - Fax:505-986-0202
Practice Address - Street 1:312 CATRON ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1806
Practice Address - Country:US
Practice Address - Phone:505-986-0606
Practice Address - Fax:505-986-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty